Page 4 - Evaluation for Harry Coverston

Both PPO plans compared in your evaluation have zero premiums for health and Rx drug
coverage, above-average four-star quality ratings, large provider networks, and high out-of-
pocket limits that are at Medicare’s maximum permitted levels. Both plans include prescription
drug coverage (Part D benefits). Following are summaries of the two plans:

1) AARP Medicare Complete Choice Plan 2 (Regional PPO). Regional PPO plans cover large
areas, typically an entire state. This plan’s 20,000+ providers, therefore, are dispersed
across Florida.

Dr. Maharaj is listed in this plan’s network, as shown in Appendix D2. Dr. Ilagen, on the
other hand, is not listed in this plan’s online provider directory. Because this is a PPO
plan, you will have some coverage when you see Dr. Ilagen but will pay substantially
more (the same principle applies for Dr. Maharaj in the other Advantage PPO plan in
your evaluation).

The cost for an out-of-network office visit to a specialist is $70 in this plan, and if the
specialist provides a treatment or procedure, you will likely pay 40% of the cost, as
shown in Appendix D2.

This plan does not provide any dental benefits, but it does include a no-cost routine eye
exam from a network optometrist or ophthalmologist. Its annual costs in 2018 for your
two drugs are $72 if you get your refills at a CVS Pharmacy. Those costs include
premiums and co-payments.

2) Humana Choice Florida Plan (Local PPO). This plan covers several Florida counties (the
Medicare web site does not indicate which ones). Since it does not cover the entire
state, though, you will likely have a greater choice of specialists in your area than you
will in the AARP Medicare Complete Choice Plan 2. Dr. Ilagen is listed in this plan’s
network but Dr. Maharaj is not.

In this plan you will pay $65 for office visits to non-network doctors like Dr. Maharaj,
and depending on the service or treatment, you could pay 50% of the cost, as shown in
Appendix D3.

This plan has good supplemental benefits for vision and dental care, including no cost
for some services if they are provided by a network optometrist or dentist. Annual costs
for your two Rx drugs at CVS are $96, including premiums and co-payments.

Rx Drug Plan Coverage

As mentioned earlier, if you purchase a Medigap policy you will also need to enroll in a Part D
stand-alone plan. For the two Rx drugs that you take, the lowest-cost stand-alone plan is the
Aetna Medicare Rx Select Plan. If you get monthly refills at CVS, your estimated 2018 costs in
this plan are $248, which includes premiums and co-payments.

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